Diagnosis from False Positives in Scans
Many patients present to physiotherapy expecting to need a scan to help with a diagnosis of their symptoms. And on the surface, this appears a totally reasonable expectation; how can you have a prognosis without a diagnosis? However recent research has come to light which has shown that scanning things early is not without complications.
To understand the results of a scan, whether ultrasound, x-ray, CT or MRI we first need to understand what is normal. Degeneration is normal. Just like grey hair and wrinkles on the skin so are changes within the muscles, joints and bones. Degenerative signs can include but are not limited to bony spurs, arthropathy, partial tears, loss in disc height, thinning of articular cartilage, tendinopathy, tendinosis, lots isn’t there? I recently attended a lecture from Dr Larissa Tommier who summarised the use of scanning in establishing a diagnosis the best I feel; “The art of medicine is summating all the evidence (scans and clinical assessment) and determining what exactly is the pain source”
So next time that you receive the results of your scan or ask for a scan, ask first about what is normal.
A table below shows what is normal for a lumbar spine dependent on age.
(Brinjikji et al., 2015)
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol, 36(4), 811-816. doi:10.3174/ajnr.A4173
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